The countdown is on. In four days, the health insurance marketplaces mandated by the Obama administration's Affordable Care Act are scheduled to open for business. As with any sizable tech project, there are bound to be glitches. But this isn't just any large tech project. It's unprecedented for the U.S. government.
Come Tuesday, every state will have its own online healthcare exchange, where citizens can browse and buy insurance from healthcare providers as if they were shopping for flights on a travel website. Consumers will be able to find out if they qualify for financial assistance and compare plans based on pricing, quality and benefits. The portals will calculate premiums and potential tax credits based on citizens' income, eligibility for subsidies, and other parameters.
Behind the scenes, a number of agencies, applications and data sources must swap information to keep the systems running.
"Homeland Security sends the citizenship information, IRS sends the income information, Social Security sends the Medicare eligibility information, and from the states you get the Medicaid eligibility," says Charlene Frizzera, president of consulting firm CF Health Advisors.
The requirements for data security and privacy are particularly onerous. Yet even before the sites launch, problems are emerging:
" Final security testing of the federal data hub, which links to databases maintained by multiple agencies and containing sensitive personal information, isn't slated to happen until Sept. 30, one day before the rollout. Lawmakers have raised significant concerns about the ability of the system to protect personal health records and other private information.
" The District of Columbia's DC Health Link marketplace announced that it won't deploy on Oct. 1 the function that makes new Medicaid eligibility determinations and calculates tax credits for purchase of private insurance "due to a high error rate discovered through extensive systems testing." Other states have reported similar functional setbacks.
" The Associated Press is reporting that online enrollment for small businesses will be delayed and business owners initially will have to mail or fax their enrollment info.
If technical glitches arise, The Centers for Medicare and Medicaid Services (CMS) is prepared to issue workarounds, industry watchers say. In addition, nobody is expecting millions of enrollments at the start of the six-month open enrollment period, particularly since coverage won't begin until Jan. 2014 -- which could buy some time.
CMS "has designed a system that they've tested to the best of their ability, and they think it works," says Frizzera, who is a former CMS acting administrator.
The agency has identified where they think the biggest risks are in the system they designed, Frizzera says. If a few of those risks materialize, CMS has prepared workarounds to handle the issues, but "they're going to have a harder time keeping up if a lot of those come to fruition," she says.
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